Lower Third Of Face Research Articles

A Prospective Trial: Handsfree Thermoregulated Bipolar Radiofrequency for Face and Neck Contouring.

Background:The use of radiofrequency in aesthetic surgery has evolved significantly since it was first introduced in the early 2000s. Nonexcisional correction of the lower one-third of the face and neck has long been a challenging problem. The purpose of this prospective study was to assess the safety and efficacy of the first handsfree thermoregulated bipolar radiofrequency device for face and neck contouring.Methods:This prospective multicenter (New York, Nevada) IRB-approved study evaluated healthy candidates who desired noninvasive correction of their lower face and neck laxity. The primary objective of this study was to evaluate safety and soft tissue remodeling pretreatment and at 1-, 3-, and 6-months post last treatment. Assessment was made using blinded evaluators, 3D photographic analysis (Quantificare, France), and volumetric measurements. Investigator and subject assessments were obtained using a 0-4 point Likert scale.Results:A total of 34 patients completed both the cheek and chin applicator treatment series. Average age of patients was 38 (STD 3.4), BMI 27 (STD 2.2), average Baker Face & Neck classification 2.6 (STD 1.1), and average Fitzpatrick type 2.4 (STD 1.2). Mean treatment time was 41 min (STD 3.5) with a temperature of 42°C–43°C. Patient discomfort data were statistically very low based on t-test analysis. Satisfaction metrics measured at 1- and 3-month follow-up demonstrated a significant change in subject skin appearance, subject overall satisfaction, and investigator improvement perception. More patients were satisfied at the 3-month follow-up compared with the 1-month follow-up for all three measures. Volumetric data demonstrated an average change of −3.2 cm3 (STD ±1.2 cm3) per side for the cheek applicator and −4.1 (STD ±2.3) for the submental applicator. Of note there were cases where volume increases were noted that were believed to be related to soft tissue contraction.Conclusions:This is the first prospective study to evaluate a handsfree thermoregulated bipolar radiofrequency device for face and neck contouring. This device demonstrates a significant advance in the control and delivery of radiofrequency for aesthetic purposes. With a favorable safety and comfort profile, this device is able to concentrate thermal energy consistently at a depth that allows for fibroseptal network tightening to improve lower third of face and submental soft tissue contraction.

Protocols of digital diagnostics in patients with reduced lower third of the face

Determination of interalveolar height and centric relationship is a crucial problem in clinical dental practice, because possible failures lead to non-physiological position of mandible, which, in turn, can cause development of temporomandibular joint dysfunction and masticatory muscles disorders. The aim was to improve traditional protocol for determining interalveolar height and centric relationship in patients with reduced lower third of face. Materials and methods. 75 patients (27 men and 48 women) with tooth wear of II—III degree of severity and reduced lower third of face, suffered from pain, tension, fatigue, hypertension of masticatory muscles were examined. All patients were determined interalveolar height and centric relationship using the proposed method: first of all, instrumental diagnostics was performed (anatomico-instrumental method for determining interalveolar height and centric relationship with the help of gnathometer, created using special computer programs), and then the X-ray one (cone-beam computed tomography of temporomandibular joints with fixed together gnathometer’s bases in patient’s mouth). This method is described in clinical case. Results. It was achieved optimal condylar position and no pain in temporomandibular joints and masticatory muscles in the patient. Conclusion. Thus, high accuracy of diagnostics is achieved, due to the use of digital technologies at all clinical and laboratory stages.

Customised Ball Attachment Retained Cheek Plumpers to Enhance Facial Aesthetics: A Case Report

Facial aesthetics plays a very important role in dentistry. Loss of teeth leads to the resorption of alveolar ridges, loss of support to the facial musculature resulting in diminished facial muscle tone, all of which lead to the slumping of the cheek. Authors here by present a case of a 59-year-old male patient who reported with the complaint of missing upper and lower teeth. Intraoral examination revealed completely edentulous maxillary and mandibular arches. Extraoral examination revealed sunken cheek and wrinkling of the skin. The patient was more concerned about his hollow cheek, so the treatment option advised for him was complete denture with detachable cheek plumpers. The technique used here precisely determines available space for cheek plumpers. But, despite of providing the maxillary cheek plumper, appearance of hollow cheek remained in lower third of face. So, the mandibular cheek plumper was also planned. This case report a novel, simple, straightforward, cost-effective and noninvasive technique of fabricating detachable cheek plumpers for maxillary and mandibular denture using customised ball attachment.

Relating Facial Asymmetry with Mandibular Morphometric Parameters: A CBCT Study

Introduction: It is imperative to have a sound knowledge of causes and various aspects of facial asymmetry. Objectives: To evaluate asymmetry in the lower third of face, correlate the asymmetry with morphological features of the mandible, to correlate the dental and skeletal asymmetry in the mandible and to determine a correlation between these parameters and skeletal asymmetry at point menton using CBCT. Methods: Pre-treatment records of 15 patients (07 males and 08 females, aged 16.93 ± 2.19 years) with asymmetry of lower third of face due to unknown aetiology and chin deviated to right (Group A, study group) were compared with 15 patients (07 males and 08 females, aged 16.12 ± 2.06 years) presenting with no gross facial asymmetry (Group B, control group). Multiplanar Reformation view of CBCT data in sagittal plane was used to assess condylar height, ramus length and mandibular body length in both groups. Results: The mean condylar heights on both sides were similar in Group B (P-value > 0.05). The condylar height on right side in Group A was smaller compared to the left side condyles in both groups (P-value < 0.001). No significant difference was observed in mean ramus and body length between the 02 groups (P-value > 0.05). The skeletal midline deviation was higher compared to the dental midline deviation towards right in Group A (P-value < 0.001). Conclusion: Condylar height is an important factor responsible for asymmetry of the lower third of the face and deviation of chin in adolescent patients with asymmetry of unknown aetiology.

Mandibular angle resection using cervicofacial lifting surgical approach: Technical note

Facial feminization surgery brings a set of surgical procedures that address the three thirds of the face and aims to give feminine characteristics to a masculine face. The characteristics of the lower third of a male face are a long, broad chin, a prominent mandible with sharp angles (in connection with the insertions of the masseter muscles). Mandibular angle reduction is an important procedure of the male-to-female transformation. It allows to modify the appearance of the lower third of the face, reducing the bi-mandibular distance in the coronal plane and opening the mandibular angle in profile. The classical procedure uses trans-oral surgical approach. However, patients undergoing male-to-female sexual transformation frequently present a mixed indication of cervicofacial lift and angular resection. We present an innovative surgical technique associating cervicofacial lifting and mandibular angle resection using the same cutaneous surgical approach. We describe its advantages and discuss its disadvantages.

Three-dimensional evaluation of facial asymmetry in patients with hemifacial microsomia using stereophotogrammetry

PurposeTo quantify the surface facial asymmetry in a group of young patients with hemifacial microsomia (HFM) and to investigate differences with a homogeneous sample of healthy subjects, using a novel stereophotogrammetric method. Materials and methodsTwelve patients (mean age 13.1 ± 3.1 years) with different degrees of HFM and 15 healthy controls (mean age 12.2 ± 3.5 years) were imaged with a stereophotogrammetric facial scanner. The root mean square error (RMSE) of the distances between the corresponding points of each original photograph and its mirror copy was calculated for the whole face and for each trigeminal third, as defined by the innervation of trigeminal branches. A statistical analysis was performed to compare the RMSE value of all facial areas within each group and between patients and controls. ResultsRMSE values progressively increased from the upper to the lower third of face, both in patients and controls. The level of asymmetry was significantly higher in HFM subjects for middle third (p < 0.01), lower third (p < 0.001) and whole face (p < 0.001); no statistically significant differences were found between the groups for the upper third. ConclusionsThe reported technique provides an accurate topographic analysis of the facial asymmetry, and is recommended for conditions such as HFM affecting only part of the face.

Epidemiology and Risk Factors of Maxillofacial Injuries in Brazil, a 5-year Retrospective Study.

The etiology and epidemiology of maxillofacial injuries varies widely in different regions of the world due to socioeconomic status, cultural aspects in addition to road traffic and drug consumption. The aim of this study is to determine major causes and epidemiological characteristics of maxillofacial trauma in a 5-year period. Reports of corporal trauma (n=25,632) from 2007 to 2011 in the Department of Forensic Medicine were analyzed as to the presence of maxillofacial injuries. Data were submitted to Chi square test and to multivariate Poisson regression. 3262 reports referred maxillofacial trauma. The majority were men (55.8%), single (68.9%), most of them white (75.7%). The average age was 28.9years (SD=8.42), and victims with age between 16 and 30years old were the most affected (48.0%). Women comprised 44% of total sample, 67.8% (971) were single, 76% (1.076) white and 46% (691) aged between 16 and 30years old. Middle third injuries were associated after adjustment with females (PR 1.05; 95% CI 1.01-1.11), non-white subjects (PR 1.06; 95% CI 1.01-1.12) and physical aggression (PR 1.07; 95% CI 1.02-1.13). Injuries in the oral region was more prevalent in men (PR 1.24; 95% CI 1.09-1.41), in those aged between 16 and 30 (PR 1.97; 95% CI 1.48-2.61) and in subjects with injuries caused by traffic accident (PR 1.21; 95% CI 1.02-1.44). The presence of injuries in the lower third of face remained associated in the final model only with traffic accident (PR 1.75; 95% CI 1.43-2.15). Health care practitioners must recognize vulnerable population and most prevalent sites of lesion to identify cases of violence.

Evaluation of Asymmetries associated with Class II subdivision malocclusions and Normal occlusion.

Aim: The objective of this study was to compare the dental and skeletal asymmetry seen in subjects with Class II subdivision malocclusion and normal occlusion. Materials and Methods: The sample consisted of 30 subjects in each group with Angle Class II subdivision malocclusions and with Angle Class I malocclusions. Postero-Anterior cephalographs were obtained from each subject. The cephalometric measurements were obtained according to the method described by Grummon's and Van de Coppell. Results are expressed as Mean and Standard Deviation. Differences between two groups are compared by unpaired t test. P = 0.05 or less was considered as statistically significant. Results: Sub-division cases exhibited 10.5% more asymmetry with angular measurements and exhibited 38% more asymmetry with linear measurements as compared with normal group. Conclusion: There was a significant amount of radiographic mandibular asymmetry in relation to Class II subdivision malocclusions in general. As a consequence of the more frequent asymmetry in the lower third of face, the mandibular dental midline and the antegonial angle were deviated on the Class II side, as evaluated on the postero-Anterior radiograph.

A Rare Fracture of The Mandible

Maxillofacial traumas are common and mandible is most frequently fractured bone in the lower third of face. Here we report a rare horizontal fracture of mandible from right molar to left molar. Fracture was adequately reduced and fixed with two holed miniplates. The possible mechanism of such an unusual fracture is discussed. DOI: http://dx.doi.org/10.3329/bjms.v11i4.12611 Bangladesh Journal of Medical Science Vol. 11 No. 04 Oct’12

Post-operative soft tissue changes in patients with mandibular prognathism after bimaxillary surgery

The objective of this study was to evaluate the three-dimensional soft tissue changes observed over time after bimaxillary surgery for mandibular prognathism using cone-beam computed tomography (CBCT) superimposed imaging. CBCT scans were obtained for 25 patients before bimaxillary surgery (T0), at 2 months after surgery (T1) and at 6 months after surgery (T2). Cephalometric variables from the reoriented volumetric images were measured and compared at T0, T1, and T2. The quantitative surface displacement in the middle and the lower third of the facial soft tissue using CMF tools was assessed by superimposing the T0 and T1 or T0 and T2 3D images. The soft tissue in middle third of face moved forward at T1 and significantly moved backward from T1 to T2 (Ch-Al, p < 0.001; Al, p < 0.05; Pn, p < 0.05). Most of the soft tissue changes from T1 to T2 were not correlated with the hard tissue changes (p > 0.05), while the cheeks were positively correlated with the soft tissue around them (Exo-Al, p < 0.01; Ch-Al, p < 0.01). Post-operative soft tissue changes occurred in the middle third of the face and are considered to be more complex than the changes in the lower third of face. Therefore, soft tissue assessment at least 6 months after surgery is desirable.

Simultaneous Intrusion and Retraction in Begg Appliance and Evaluation of Same by Non-numerical Approach by Esthetic Analysis

Many appliances, labial and lingual have emerged with different mechanics for simultaneous intrusion and retraction. Nowadays, the temporary anchorage devices are advocated as a method of augmenting anchorage. The present case utilizes the conventional technique of archwire modification according to Hocevar in Begg's technique for true incisor intrusion and simultaneous retraction. A non-numeric approach analysis called esthetic analysis is used for lower third of face to evaluate the treatment results.

Effects of early unilateral first molar extraction on skeletal asymmetry

The purpose of this study was to investigate dental and skeletal asymmetry in patients who had unilateral first molar extractions. Two study groups were formed according to the location of the extracted first molars. Group I included 25 subjects who had a maxillary permanent first molar extracted (mean age, 18.25 years). Group II included 26 subjects who had a mandibular permanent first molar extracted (mean age, 17.75 years). The control group included 30 subjects with no missing teeth and normal occlusion (mean age, 18.50 years). Dental and skeletal asymmetry values were computed on posteroanterior radiographs for all subjects. Data were analyzed statistically with paired t tests to determine intragroup differences and with ANOVA and Scheffé tests to determine intergroup differences. Unilateral first molar extractions caused dental midline deviations in both arches, but this was more prominent in the mandibular arch. Unilateral first molar extraction during growth and development can result in remarkable skeletal asymmetry, especially in the lower third of face. Patients who had early unilateral first molar extraction can have skeletal and dental asymmetries.

Evaluation of asymmetries between subjects with Class II subdivision and apparent facial asymmetry and those with normal occlusion

The objective of this study was to compare the degree of skeletal asymmetry between subjects with Class II subdivision malocclusion and apparent facial asymmetry and subjects with normal occlusion. The sample consisted of 23 subjects with Angle Class II subdivision malocclusions and apparent facial asymmetry (mean age, 15.78 years) and 30 subjects with normal occlusions (mean age, 22.42 years). Each had all permanent teeth, including first molars. Radiographic asymmetry was assessed by measuring the relative difference in spatial position of dental and skeletal landmarks between right and left sides in both anteroposterior and transverse dimensions in the submentovertex and in the transverse and vertical dimensions in the posteroanterior radiographs. Independent t tests were used to compare radiographic asymmetries between groups. Despite the predominantly dentoalveolar nature of the asymmetries found in Class II subdivision malocclusions with apparent facial asymmetry, the radiographic mandibular asymmetry was small in relation to Class II subdivision malocclusions in general. The components that contributed to the asymmetric anteroposterior relationship in the Class II subdivision malocclusion with apparent facial asymmetry were mainly dentoalveolar. The primary contributor to the differences between the 2 groups was the distal positioning of the mandibular first molars on the Class II side. A secondary contributor was the mesial positioning of the maxillary first molars on the Class II side. As a consequence of the more frequent asymmetry in the lower third of face, the mandibular dental midline and the antegonial angle were deviated on the Class II side, as evaluated on the posteroanterior radiograph. The main component of Class II subdivision is dentoalveolar, primarily distal positioning of the first mandibular molar on the Class II side and secondarily mesial positioning of the first maxillary molar on the same side.

A computerized non-invasive method for the assessment of human facial volume

The three-dimensional coordinates of 22 standardized soft-tissue facial landmarks were used in the definition of a three-dimensional model of the adult human face. The model allows the estimation of the volume of the face in toto and of its parts (upper, middle and lower thirds, nose). Landmark coordinates were collected in 80 healthy young adults (40 men and 40 women selected according to criteria of dentofacial normality) by infrared photogrammetry by an automated instrument, and facial volumes calculated. Sample variability was larger in women than in men; the nose and the upper third of face had the largest variability regardless of gender. On average, all volumes computed in men were significantly larger than the corresponding values computed in women. Also the lower-to-middle third face ratio was significantly higher in men than in women. The sexual dimorphism in human facial volume did not involve the different parts of the face to the same extent: a large part of male facial volume preponderance was explained by the lower third of face. The proposed facial model could adequately represent the human face in all those research and clinical fields where noninvasive surface measurements could be employed alone or in support of conventional radiographic data.

The stability of facial osteotomies. 2. Mandibular advancement with bicortical screw fixation.

Surgical repositioning of the dento-skeletal components of the lower third of face, combined with appropriate orthodontic treatment, can be used to improve function and aesthetics. However, the attainment of three-dimensional stability following corrective jaw surgery continues to be a major problem in the post-surgical period. This paper examines the short-term (6 week post-operative) and long-term (12 months postoperative) horizontal skeletal stability of bilateral sagittal split mandibular advancement in 15 patients. The mean horizontal advancement of the mandible was 6.1 mm. Six weeks later, a mean continued forward movement of 0.16 mm was identified. The mean relapse at long-term follow-up was 0.46 mm (7.5%). Results indicate that rigid bicortical screw fixation of bilateral sagittal split osteotomies undertaken to correct horizontal lower dentofacial deficiency is both statistically and surgically predictable and stable when reviewed up to twelve months after surgery.

高度な顔面非対称に対して，全上下がく同時移動術およびオトガイ形成術を施行した１治験例

A 20-year 3-month man who suffered severe asymmetry in the middle and lower third of face was presented. Simultaneous mobilization of maxilla and mandible (Le Fort-I Osteotomy+ Sagittal Splitting Osteotomy) was performed to flatten occlusal plane and after 6 months Genioplasty was done to correct remaining facial asymmetry.Although minimum skeletal relapse occurred quite early after the first operation, desired facial symmetry was acquired.